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Lee T, Peirce K, Natalwala J, Chapple V, Mark PJ, Sanders K, Liu Y. Abnormal cleavage up to Day 3 does not compromise live birth and neonatal outcomes of embryos that have achieved full blastulation: a retrospective cohort study. Hum Reprod 2024; 39:955-962. [PMID: 38553025 PMCID: PMC11063553 DOI: 10.1093/humrep/deae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/22/2024] [Indexed: 05/03/2024] Open
Abstract
STUDY QUESTION Do embryos displaying abnormal cleavage (ABNCL) up to Day 3 have compromised live birth rates and neonatal outcomes if full blastulation has been achieved prior to transfer? SUMMARY ANSWER ABNCL is associated with reduced full blastulation rates but does not impact live birth rates and neonatal outcomes once full blastulation has been achieved. WHAT IS KNOWN ALREADY? It is widely accepted that ABNCL is associated with reduced implantation rates of embryos when transferred at the cleavage stage. However, evidence is scarce in the literature reporting birth outcomes from blastocysts arising from ABNCL embryos, likely because they are ranked low priority for transfer. STUDY DESIGN, SIZE, DURATION This retrospective cohort study included 1562 consecutive autologous in vitro fertilization cycles (maternal age 35.1 ± 4.7 years) performed at Fertility North, Australia between January 2017 and June 2022. Fresh transfers were performed on Day 3 or 5, with remaining embryos cultured up to Day 6 before vitrification. A total of 6019 embryos were subject to blastocyst culture, and a subset of 664 resulting frozen blastocysts was included for live birth and neonatal outcome analyses following single transfers. PARTICIPANTS/MATERIALS, SETTING, METHODS ABNCL events were annotated from the first mitotic division up to Day 3, including direct cleavage (DC), reverse cleavage (RC) and <6 intercellular contact points at the 4-cell stage (<6ICCP). For DC and RC in combination, the ratios of affected blastomeres over the total number of all blastomeres up to Day 3 were also recorded. All pregnancies were followed up until birth with gestational age, birthweight, and sex of the baby being recorded. MAIN RESULTS AND THE ROLE OF CHANCE Full blastulation rates for embryos showing DC (19.5%), RC (41.7%), <6ICCP (58.8%), and mixed (≥2) ABNCL types (26.4%) were lower than the rates for those without ABNCL (67.2%, P < 0.01 respectively). Subgroup analysis showed declining full blastulation rates with increasing ratios of combined DC/RC affected blastomeres over all blastomeres up to the 8-cell stage (66.2% when 0 affected, 47.0% when 0.25 affected, 27.4% when 0.5 affected, 14.5% when 0.75 affected, and 7.7% when all affected, P < 0.01). However, once full blastulation had been achieved, no difference was detected between DC, RC, <6ICCP, and no ABNCL blastocysts following single frozen transfers in subsequent live birth rates (25.9%, 33.0%, 36.0% versus 30.8%, P > 0.05, respectively), gestational age (38.7 ± 1.6, 38.5 ± 1.2, 38.3 ± 3.5 versus 38.5 ± 1.8 weeks, P > 0.05, respectively) and birthweight (3343.0 ± 649.1, 3378.2 ± 538.4, 3352.6 ± 841.3 versus 3313.9 ± 509.6 g, P > 0.05, respectively). Multiple regression (logistic or linear as appropriate) confirmed no differences in all of the above measures after accounting for potential confounders. LIMITATIONS, REASONS FOR CAUTION Our study is limited by its retrospective nature, making it impossible to control every known or unknown confounder. Embryos in our dataset, being surplus after selection for fresh transfer, may not represent the general embryo population. WIDER IMPLICATIONS OF THE FINDINGS Our findings highlight the incremental impact of ABNCL, depending on the ratio of affected blastomeres up to Day 3, on subsequent full blastulation. The reassuring live birth and neonatal outcomes of ABNCL blastocysts imply a potential self-correction mechanism among those embryos reaching the blastocyst stage, which provides valuable guidance for clinical practice and patient counseling. STUDY FUNDING/COMPETTING INTEREST(S) This research is supported by an Australian Government Research Training Program (RTP) Scholarship. All authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Tammy Lee
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
- Fertility North, Joondalup Private Hospital, Joondalup, WA, Australia
| | - Kelli Peirce
- Fertility North, Joondalup Private Hospital, Joondalup, WA, Australia
| | - Jay Natalwala
- Fertility North, Joondalup Private Hospital, Joondalup, WA, Australia
| | - Vincent Chapple
- Fertility North, Joondalup Private Hospital, Joondalup, WA, Australia
| | - Peter J Mark
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Katherine Sanders
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Yanhe Liu
- School of Human Sciences, The University of Western Australia, Crawley, WA, Australia
- Fertility North, Joondalup Private Hospital, Joondalup, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
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Luong TMT, Le NQK. Artificial intelligence in time-lapse system: advances, applications, and future perspectives in reproductive medicine. J Assist Reprod Genet 2024; 41:239-252. [PMID: 37880512 PMCID: PMC10894798 DOI: 10.1007/s10815-023-02973-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
With the rising demand for in vitro fertilization (IVF) cycles, there is a growing need for innovative techniques to optimize procedure outcomes. One such technique is time-lapse system (TLS) for embryo incubation, which minimizes environmental changes in the embryo culture process. TLS also significantly advances predicting embryo quality, a crucial determinant of IVF cycle success. However, the current subjective nature of embryo assessments is due to inter- and intra-observer subjectivity, resulting in highly variable results. To address this challenge, reproductive medicine has gradually turned to artificial intelligence (AI) to establish a standardized and objective approach, aiming to achieve higher success rates. Extensive research is underway investigating the utilization of AI in TLS to predict multiple outcomes. These studies explore the application of popular AI algorithms, their specific implementations, and the achieved advancements in TLS. This review aims to provide an overview of the advances in AI algorithms and their particular applications within the context of TLS and the potential challenges and opportunities for further advancements in reproductive medicine.
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Affiliation(s)
- Thi-My-Trang Luong
- International Master Program in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
- AIBioMed Research Group, Taipei Medical University, Taipei, 110, Taiwan
| | - Nguyen Quoc Khanh Le
- AIBioMed Research Group, Taipei Medical University, Taipei, 110, Taiwan.
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan.
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, 110, Taiwan.
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei, 110, Taiwan.
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Garcia-Belda A, Cairó O, Martínez-Moro Á, Cuadros M, Pons MC, de Mendoza MVH, Delgado A, Rives N, Carrasco B, Cabello Y, Figueroa MJ, Cascales-Romero L, González-Soto B, Cuevas-Saiz I. Considerations for future modification of The Association for the Study of Reproductive Biology embryo grading system incorporating time-lapse observations. Reprod Biomed Online 2024; 48:103570. [PMID: 37952277 DOI: 10.1016/j.rbmo.2023.103570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
The Association for the Study of Reproductive Biology (ASEBIR) Interest Group in Embryology (in Spanish 'Grupo de Interés de Embriología') reviewed key morphokinetic parameters to assess the contribution of time-lapse technology (TLT) to the ASEBIR grading system. Embryo grading based on morphological characteristics is the most widely used method in human assisted reproduction laboratories. The introduction and implementation of TLT has provided a large amount of information that can be used as a complementary tool for morphological embryo evaluation and selection. As part of IVF treatments, embryologists grade embryos to decide which embryos to transfer or freeze. At the present, the embryo grading system developed by ASEBIR does not consider dynamic events observed through TLT. Laboratories that are using TLT consider those parameters as complementary data for embryo selection. The aim of this review was to evaluate review time-specific morphological changes during embryo development that are not included in the ASEBIR scoring system, and to consider them as candidates to add to the scoring system.
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Affiliation(s)
| | | | - Álvaro Martínez-Moro
- IVF Spain Madrid, Madrid, Spain.; Animal Reproduction Department, INIA-CSIC, Madrid, Spain
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Bamford T, Barrie A, Montgomery S, Dhillon-Smith R, Campbell A, Easter C, Coomarasamy A. Morphological and morphokinetic associations with aneuploidy: a systematic review and meta-analysis. Hum Reprod Update 2022; 28:656-686. [PMID: 35613016 DOI: 10.1093/humupd/dmac022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/10/2022] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND A time lapse system (TLS) is utilized in some fertility clinics with the aim of predicting embryo viability and chance of live birth during IVF. It has been hypothesized that aneuploid embryos display altered morphokinetics as a consequence of their abnormal chromosome complement. Since aneuploidy is one of the fundamental reasons for IVF failure and miscarriage, attention has focused on utilizing morphokinetics to develop models to non-invasively risk stratify embryos for ploidy status. This could avoid or reduce the costs associated with pre-implantation genetic testing for aneuploidy (PGT-A). Furthermore, TLS have provided an understanding of the true prevalence of other dysmorphisms. Hypothetically, the incorporation of morphological features into a model could act synergistically, improving a model's discriminative ability to predict ploidy status. OBJECTIVE AND RATIONALE The aim of this systematic review and meta-analysis was to investigate associations between ploidy status and morphokinetic or morphological features commonly denoted on a TLS. This will determine the feasibility of a prediction model for euploidy and summarize the most useful prognostic markers to be included in model development. SEARCH METHODS Five separate searches were conducted in Medline, Embase, PubMed and Cinahl from inception to 1 July 2021. Search terms and word variants included, among others, PGT-A, ploidy, morphokinetics and time lapse, and the latter were successively substituted for the following morphological parameters: fragmentation, multinucleation, abnormal cleavage and contraction. Studies were limited to human studies. OUTCOMES Overall, 58 studies were included incorporating over 40 000 embryos. All except one study had a moderate risk of bias in at least one domain when assessed by the quality in prognostic studies tool. Ten morphokinetic variables were significantly delayed in aneuploid embryos. When excluding studies using less reliable genetic technologies, the most notable variables were: time to eight cells (t8, 1.13 h, 95% CI: 0.21-2.05; three studies; n = 742; I2 = 0%), t9 (2.27 h, 95% CI: 0.5-4.03; two studies; n = 671; I2 = 33%), time to formation of a full blastocyst (tB, 1.99 h, 95% CI 0.15-3.81; four studies; n = 1640; I2 = 76%) and time to expanded blastocyst (tEB, 2.35 h, 95% CI: 0.06-4.63; four studies; n = 1640; I2 = 83%). There is potentially some prognostic potential in the degree of fragmentation, multinucleation persisting to the four-cell stage and frequency of embryo contractions. Reverse cleavage was associated with euploidy in this meta-analysis; however, this article argues that these are likely spurious results requiring further investigation. There was no association with direct unequal cleavage in an embryo that progressed to a blastocyst, or with multinucleation assessed on Day 2 or at the two-cell stage. However, owing to heterogeneous results and poor-quality evidence, associations between these morphological components needs to be investigated further before conclusions can be reliably drawn. WIDER IMPLICATIONS This first systematic review and meta-analysis of morphological and morphokinetic associations with ploidy status demonstrates the most useful morphokinetic variables, namely t8, t9 and tEB to be included in future model development. There is considerable variability within aneuploid and euploid embryos making definitively classifying them impossible; however, it is feasible that embryos could be prioritized for biopsy. Furthermore, these results support the mechanism by which algorithms for live birth may have predictive ability, suggesting aneuploidy causes delayed cytokinesis. We highlight significant heterogeneity in our results secondary to local conditions and diverse patient populations, therefore calling for future models to be robustly developed and tested in-house. If successful, such a model would constitute a meaningful breakthrough when accessing PGT-A is unsuitable for couples.
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Affiliation(s)
| | | | | | - Rima Dhillon-Smith
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | | | - Christina Easter
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, UK
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Ferraretto X, Hammas K, Llabador MA, Gricourt S, Labrosse J, Lousqui J, Epelboin S, Tubiana S, Patrat C. Early embryo development anomalies identified by time-lapse system: prevalence and impacting factors. Reprod Biomed Online 2021; 43:627-636. [PMID: 34474978 DOI: 10.1016/j.rbmo.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/17/2021] [Accepted: 06/11/2021] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What is the prevalence of embryo abnormal early cleavage (ACL) identified by time lapse and factors related to patients and treatment that explain ACL occurrence? DESIGN A single-centre, retrospective cohort study. Data were collected on all IVF cycles for which embryos were observed in the EmbryoScope® between December 2015 and August 2017. Only diploid zygotes cleaved on day 2 were included. The study included 318 cycles (250 couples and 1343 embryos). Embryo videos were retrospectively analysed for ACL. The prevalence of each type of ACL was recorded. The influence of clinical factors (whether they were intrinsic to patients or specific to IVF treatment) on ACL occurrence was analysed in multivariate multilevel mixed-effect logistic regression analysis. RESULTS A high prevalence of ACL was observed: 37.6% (505/1343) of embryos presented at least one ACL, 22.8% (306/1343) a trichotomous mitosis, 25.8% (347/1343) a rapid cleavage, 6.7% (90/1343) a cell fusion and two or more ACL (16.1%). Part of the variation (12-25%) in ACL occurrence could be explained by embryo origin. Trichotomous mitosis and two or more ACL phenotypes were less likely to occur in women with endometriosis or tubal pathology and tubal pathology alone, respectively. No factor related to IVF cycles was found to be statistically associated with ACL occurrence. CONCLUSIONS Our findings emphasize the importance of considering embryo origin when interpreting studies focusing on embryo characteristics and factors that could affect their quality. The present study is limited by a small sample size of known embryo implantations and monocentric criterion.
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Affiliation(s)
- Xavier Ferraretto
- Service de Biologie de la Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Karima Hammas
- Departement d'Epidemiologie, Biostatistiques et Recherche Clinique, AP-HP.Nord -Université de Paris 75018, Hôpital Bichat, Paris, France; Inserm, CIC-EC 1425, Hôpital Bichat Claude Bernard, Paris 75018, France
| | - Marie-Astrid Llabador
- Service de Biologie de la Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Solenne Gricourt
- Service de Gynécologie, Obstétrique et Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Julie Labrosse
- Service de Gynécologie, Obstétrique et Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Johanna Lousqui
- Service de Biologie de la Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Sylvie Epelboin
- Service de Gynécologie, Obstétrique et Reproduction, AP-HP.Nord - Université de Paris, Hôpital Bichat, Paris 75018, France
| | - Sarah Tubiana
- Departement d'Epidemiologie, Biostatistiques et Recherche Clinique, AP-HP.Nord -Université de Paris 75018, Hôpital Bichat, Paris, France; Inserm, CIC-EC 1425, Hôpital Bichat Claude Bernard, Paris 75018, France
| | - Catherine Patrat
- Service de Biologie de la Reproduction-CECOS, AP-HP.Centre - Université de Paris, Hôpital Cochin, Paris 75014, France; Université de Paris, Institut Cochin, U1016-CNRS UMR8104, Paris 75014, France.
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Ozbek IY, Mumusoglu S, Polat M, Bozdag G, Sokmensuer LK, Yarali H. Comparison of single euploid blastocyst transfer cycle outcome derived from embryos with normal or abnormal cleavage patterns. Reprod Biomed Online 2021; 42:892-900. [PMID: 33810985 DOI: 10.1016/j.rbmo.2021.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/16/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
RESEARCH QUESTION To assess incidence of abnormal cleavage among biopsied blastocysts; to compare euploidy rates of the blastocysts with abnormal and normal cleavage; and to compare single euploid blastocyst transfer (SEBT) outcome derived from embryos with normal or abnormal cleavage. DESIGN Retrospective analysis of prospectively collected data in a private IVF clinic. Consecutive 554 patients (749 cycles) undergoing preimplantation genetic testing for aneuploidy (n = 497; 671 cycles) or monogenic diseases (n = 57; 78 cycles) were included. All assessments for abnormal cleavage were carried out retrospectively; presence of abnormal cleavage was not a factor in deciding which euploid embryo to transfer. A total of 1015 blastocysts were biopsied and 295 SEBT procedures were carried out. Main outcome measure was live birth rate (LBR). RESULTS Incidence of reverse cleavage, direct cleavage, and reverse plus direct cleavage, were 7.7%, 6.4% and 2.3%, respectively. Of the 1015 biopsied blastocysts, 35.0% were euploid. Blastocysts with abnormal cleavage, in total, had a significantly higher euploidy rate compared with blastocysts with normal cleavage (44.6% [74/166] versus 33.1% [281/849]; P = 0.017). The LBR after SEBT with normal, reverse and direct cleavage, and direct cleavage plus reverse cleavage, was 133/238 (55.9%), 6/26 (23.1%), 8/24 (33.3%) and 0/3 (0.0%) (P < 0.001). Generalized estimating equation analysis showed that the presence of abnormal cleavage pattern was the only independent predictor of LBR (OR 0.316; 95% CI 0.115 to 0.867; P = 0.013). CONCLUSIONS Blastocysts with direct or reverse cleavage should be biopsied in preimplantation genetic testing cycles if they are morphologically eligible. Euploid blastocysts with abnormal cleavage, however, have approximately half the LBR of those euploid blastocyst with normal cleavage, hence, blastocysts with abnormal cleavage should have lower priority for transfer.
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Affiliation(s)
| | - Sezcan Mumusoglu
- Hacettepe University, Department of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehtap Polat
- Anatolia IVF and Women Health Center, Obstetrics and Gynecology, Ankara, Turkey
| | - Gurkan Bozdag
- Hacettepe University, Department of Obstetrics and Gynecology, Ankara, Turkey
| | | | - Hakan Yarali
- Hacettepe University, Department of Obstetrics and Gynecology, Ankara, Turkey; Anatolia IVF and Women Health Center, Obstetrics and Gynecology, Ankara, Turkey.
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Kobayashi M, Kobayashi J, Shirasuna K, Iwata H. Abundance of cell-free mitochondrial DNA in spent culture medium associated with morphokinetics and blastocyst collapse of expanded blastocysts. Reprod Med Biol 2020; 19:404-414. [PMID: 33071643 PMCID: PMC7542021 DOI: 10.1002/rmb2.12344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/22/2020] [Accepted: 07/25/2020] [Indexed: 01/28/2023] Open
Abstract
Purpose This retrospective observational study investigated relationships between the abundance of cell‐free mitochondrial DNA (cf‐mtDNA) in spent culture medium (SCM) of human‐expanded blastocysts and their morphokinetics to address the question of whether the abundance of cf‐mtDNA in SCM could predict the quality of blastocysts. Methods Embryos (n = 53) were individually cultured in a time‐lapse incubator until they reached the expanded blastocyst stage (5 or 6 days), following which copy numbers of cf‐mtDNA in SCM (20 μL) of expanded blastocysts were determined using real‐time PCR. Results The duration between start of blastulation to expanded blastocyst (tEB–tSB) and between that of the blastocyst stage to expanded blastocyst (tEB–tB) significantly and positively correlated with the abundance of cf‐mtDNA in the SCM (tEB–tSB: r = .46; P < .01; tEB–tB: r = .47; P < .01). The abundance of cf‐mtDNA in the SCM was significantly greater in blastocysts with blastocyst collapse (BC), than without BC, and significantly and positively correlated with the number of BC. Conclusions The abundance of cf‐mtDNA in the SCM was associated with expansion duration and BC. Thus, cf‐mtDNA abundance in the SCM serves as a marker to predict the quality of expanded blastocysts.
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Affiliation(s)
- Mitsuru Kobayashi
- Department of Animal Science Tokyo University of Agriculture Atsugi Japan.,Kanagawa Ladies Clinic Yokohama Japan
| | | | - Koumei Shirasuna
- Department of Animal Science Tokyo University of Agriculture Atsugi Japan
| | - Hisataka Iwata
- Department of Animal Science Tokyo University of Agriculture Atsugi Japan
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Liu Y, Qi F, Matson P, Morbeck DE, Mol BW, Zhao S, Afnan M. Between-laboratory reproducibility of time-lapse embryo selection using qualitative and quantitative parameters: a systematic review and meta-analysis. J Assist Reprod Genet 2020; 37:1295-1302. [PMID: 32361919 PMCID: PMC7311559 DOI: 10.1007/s10815-020-01789-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the between-laboratory reproducibility of embryo selection/deselection effectiveness using qualitative and quantitative time-lapse parameters. METHODS A systematic search was performed on MEDLINE, EMBASE, and the Cochrane Library (up to February 2020) without restriction on date, language, document type, and publication status. Measuring outcomes included implantation, blastulation, good-quality blastocyst formation, and euploid blastocyst. RESULTS We detected 6 retrospective cohort studies externally validating the first clinical time-lapse model (Meseguer) emphasizing quantitative parameters, of which 3 (including one involving 2 independent centers) were included for the pooled analysis. Receiver operating characteristics analysis showed reduced predictive power of the model when either including or not including sister clinic validation. Fifteen cohort studies evaluating qualitative parameters were included for meta-analysis, and the mean Newcastle-Ottawa Scale was 5.3. Overall, meta-analysis showed significantly adverse association between the presence of ≥ 1 cleavage abnormalities and embryo implantation rates (11 studies, n = 7266; RR = 0.39[0.28, 0.55]95% CI; I2 = 57%). Further analysis showed adverse impacts of direct cleavage (7 studies, n = 7065; RR = 0.28 [0.15, 0.54] 95% CI; I2 = 46%), reverse cleavage (2 studies, n = 3622; RR = 0.16 [0.03, 0.75] 95% CI; I2 = 0%), chaotic cleavage (2 studies, n = 3643; RR = 0.11 [0.02, 0.69] 95% CI; I2 = 24%), and multinucleation (5 studies, n = 2576; RR = 0.59 [0.50, 0.69] 95% CI; I2 = 0%), but not the < 6 intercellular contact points at the 4-cell stage (1 study, n = 185; RR = 0.17 [0.02, 1.15] 95% CI). CONCLUSIONS Qualitative time-lapse parameters are reliably associated with embryo developmental potential among laboratories, whereas the reproducibility of time-lapse embryo selection model that emphasizes quantitative parameters may be compromised when externally applied.
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Affiliation(s)
- Yanhe Liu
- Reproductive Medicine Center, Tianjin United Family Hospital, Tianjin, China. .,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia. .,School of Human Sciences, The University of Western Australia, Crawley, Australia.
| | - Fang Qi
- Systematic Review Solutions Ltd, Shanghai, China
| | - Phillip Matson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | | | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Sai Zhao
- Systematic Review Solutions Ltd, Shanghai, China
| | - Masoud Afnan
- Department of Obstetrics and Gynaecology, Qingdao United Family Hospital, Qingdao, China
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Apter S, Ebner T, Freour T, Guns Y, Kovacic B, Le Clef N, Marques M, Meseguer M, Montjean D, Sfontouris I, Sturmey R, Coticchio G. Good practice recommendations for the use of time-lapse technology †. Hum Reprod Open 2020; 2020:hoaa008. [PMID: 32206731 PMCID: PMC7081060 DOI: 10.1093/hropen/hoaa008] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 01/29/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
| | | | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Kepler Universitätsklinikum, Linz, Austria
| | - Thomas Freour
- Médecine de la Reproduction, CHU de Nantes, Nantes, France
| | - Yves Guns
- Center for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - Borut Kovacic
- Department of Reproductive Medicine and Gynecologic Endocrinology, Univerzitetni klinicni center Maribor, Maribor, Slovenia
| | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology, Grimbergen, Belgium
| | | | - Marcos Meseguer
- IVF Laboratory, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Debbie Montjean
- Médecine et Biologie de la Reproduction, Hopital Saint Joseph, Marseille, France
| | | | - Roger Sturmey
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
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Ebner T, Höggerl A, Oppelt P, Radler E, Enzelsberger SH, Mayer RB, Petek E, Shebl O. Time-lapse imaging provides further evidence that planar arrangement of blastomeres is highly abnormal. Arch Gynecol Obstet 2017; 296:1199-1205. [DOI: 10.1007/s00404-017-4531-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022]
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